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Penis and scrotum
Squamous cell carcinoma and variants
Warty-basaloid carcinoma
Editor: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 16 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Recently described variant of penile carcinoma composed of mixed features of warty and basaloid carcinomas showing >10% of either warty or basaloid component
Epidemiology
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● Mean age 62 years
● 10% of penile squamous cell carcinomas, in both low and high incidence regions (Int J Surg Pathol 2009 Jul 3 [Epub ahead of print])
Sites
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● Glans, coronal sulcus and especially inner foreskin
● Most tumors invade multiple anatomical compartments
Etiology
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● Most cases are HPV positive
Clinical behavior
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● More aggressive than pure warty carcinoma but less than basaloid carcinoma
● Inguinal nodal metastasis in 50% of patients
● 5 and 10-year survival rates of 69% and 61% respectively
● Mean survival time of 2.8 years (Mod Pathol 2010 Mar 19 [Epub ahead of print])
● Cancer-specific mortality rate of 33%
Prognostic factors
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● Higher proportions of basaloid cells are associated with more aggressive behavior
● Tumors invading deeper and with perineural invasion show a higher metastatic rate
Gross description (Macroscopy)
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● White-gray irregular mass ranging from exophytic to endophytic
● Mean size 5.5 cm (range 2-12 cm)
● Frequent invasion of deep erectile tissues
Micro description (Histopathology)
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● Areas of warty carcinoma intermingled with others showing basaloid features
● Areas of basaloid carcinoma usually predominate
● Frequent vascular and perineural invasion
● PeIN in adjacent areas with basaloid and/or warty features
Patterns of growth
● Typical condylomatous tumor on surface and deep infiltrative nests with basaloid features (most common pattern)
● Non-papillomatous invasive nests exhibiting central warty features and peripheral basaloid aspect
● Predominantly papillomatous with papillae composed of central basaloid cells and peripheral warty features
Micro images
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Contributed by Dr. Alcides Chaux and Dr. Antonio Cubilla:
Deeply infiltrative tumor nest composed of Exophytic tumor with papillae lined by cells with
a dual population of peripheral basaloid basaloid features in the lower 2/3 and clear
cells and central clear cells with koilocytic koilocytic cells in the upper 1/3 of the
features. epithelium. Note also the spiky surface and the
presence of parakeratosis.
Differential Diagnosis
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● Basaloid carcinoma (pure): if present, warty areas represent <10% of tumor mass
● Warty carcinoma (pure): basaloid areas, if present, represent <10% of tumor mass
End of Penis and scrotum > Squamous cell carcinoma and variants > Warty-basaloid carcinoma
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